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12- <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Faeility Names Tank I Site. <br /> Product <br /> Facility-*Address: 6rj Z(, <br /> 1320 kir s 'W1-A -2 S N <br /> Telephone : <br /> Person Filing <br /> Report , L `l e <br /> t.7Ck <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> Quarter. (No in Colum 13 of the Inventory Reconciliation Sheet) <br /> ❑ Inventocy variations exceeded the allowable limits for this Quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) reles' se. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tack /, and amount for all variations that exceeded the <br /> allowable limits. 1/p ' <br /> Date Tank / Amount <br /> OCT 1988 <br /> 3. <br /> EN'VJN'0N1v1EN-1,',L iiEALTH <br /> 4. PLW!T/SERV!C'ES <br /> 5. <br /> Additional dates/amouets shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J .L.H . D. Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --) June <br /> `Quarter 3 - July --) September <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEAL1'li DISTRICT <br /> 1601 E. Ilazeltiai , P .O . Box 2009 <br /> Stockton , CA 95201 466-6761 <br /> UCT 40 10/86 <br />